Provider Demographics
NPI:1053696534
Name:ARCH ANGEL SERVICES, LLC
Entity type:Organization
Organization Name:ARCH ANGEL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTUAN
Authorized Official - Middle Name:DURALL
Authorized Official - Last Name:WILBON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:312-474-6189
Mailing Address - Street 1:10 S RIVERSIDE PLZ
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-3728
Mailing Address - Country:US
Mailing Address - Phone:312-474-6189
Mailing Address - Fax:312-474-6099
Practice Address - Street 1:10 S RIVERSIDE PLZ
Practice Address - Street 2:SUITE 1800
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-3728
Practice Address - Country:US
Practice Address - Phone:312-474-6189
Practice Address - Fax:312-474-6099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health